The Case for Cultural Competence

There was praise as well as grumbling last March after New Jersey's acting governor, Richard J. Codey, signed legislation requiring doctors to take cultural-competency training to qualify for a license by the State Board of Medical Examiners. Some physicians felt the move was unnecessary—akin to taking continuing medical education (CME) courses to remind doctors of medical ethics.

Others felt it would benefit minority groups that were not receiving an adequate level of healthcare. But it seemed to make an impact on legislators in Arizona, Illinois, and New York; all three states also are considering similar bills to require doctors to take cultural-competency training.

Two CME experts—Ruben Gutierrez, director of Sudler & Hennessey's multicultural education and managing director of IntraMed, and Annemarie Armani, senior medical director of Imprint Science—know how important it is to incorporate multicultural education into physician-education programs. As the country's minority population grows, they feel it is necessary to provide proper education and sensitivity training to today's health practitioners. Gutierrez and Armani explain why doctors need to be aware of conditions ethnic groups might be predisposed to, how to factor in cultural differences when prescribing treatment, and how to provide the tools and information to ensure that everyone receives better healthcare quality.

Pharm Exec: Why is multicultural education so important? Obviously it improves healthcare for the ethnic population, but how can doctors who treat them benefit?

Ruben Gutierrez

Gutierrez: Physicians continue to acknowledge that they don't have the skills to properly communicate and care for ethnic patients, therefore, multicultural education is essential to healthcare providers because it will provide them with the necessary training and tools to assist in breaking down cultural barriers. Language-specific clinical tools and patient-education tools will enable doctors to communicate easier, and will allow patients to obtain information in a language they can better understand. These tools also facilitate joint decision-making, setting and following a prescribed regimen, and ultimately improved adherence to prescribed medications. Additionally, it will provide doctors with multicultural credit, which is now required in several states and clearly something that will become a mandate across the US.

It is a struggle to get doctors engaged at medical-education meetings. Do you think it is more important for meeting planners to create whole meetings specifically for doctors who have a number of diverse patients, or just create targeted breakout sessions?

Annemarie Armani

Armani: Yes, it is clearly a struggle to get doctors to participate in meetings, and almost surely they will not attend a meeting on multicultural education alone. In response, multicultural education needs to be targeted. It has to address not only the needs of specific cultures, but also to focus on specific disease states.

This has to be done creatively to ensure delivery of practical and useful information to the faculty that will benefit the most from it. To that end, geography and selecting the proper location for educational meetings play a key role in response, especially during these early stages.

But clearly, the American cardiologist needs to better understand our African-American population and culture, so that he or she can properly diagnose and manage cardiovascular diseases, taking into account risk, lifestyle, biology, diet, level of education, and other factors.

The same is true of the endocrinologist who is treating a Hispanic patient, the infectious disease specialist, and so on. Therefore, focusing on specific issues that are particularly relevant to these physicians will create interest. Providing suitable information on the right approach and appropriate tools for specific diseases will be critical.

In terms of participating once at the actual meeting, we've seen that an interactive approach and small group sessions facilitate dialogue and understanding, which in turn enhances the value of the educational activity.

With this in mind, breakout sessions as part of a larger program could certainly be appropriate and valuable in engaging participants and leaving them with a useful experience.